The doctors said their Ramadan fast would be invalid (“makruh”) because he was “unclean” and also belonged to a low caste. The word for low caste, “chuhra”, is especially derogatory, and is reserved for sanitary workers and often used in Pakistan synonymously for “Christian.”

“Most Pakistani Christians today still do the same work as their untouchable ancestors…” – Ethan Casey

Irfan Masih died on June 1, in Umar Kot Civil Hospital, Sindh, 300 kilometres from Karachi. Umar Kot has about 75 Christian families; almost all of them work as sanitary workers, a job that many Muslims refuse to do.

As Christianity Today writer Ethan Casey notes about Pakistan: “Most Pakistani Christians today still do the same work as their untouchable ancestors: sweeping the streets and doing other menial jobs formerly deemed ritually or literally unclean by higher-caste.”

A number of Umar Kot Christians blocked a crossing after Irfan Masih’s death, demanding that a criminal case be registered against the three doctors. Senior Superintendent of Police Usman Javed Bajwa told World Watch Monitor that a case of murder by negligence had eventually been registered, and the police would submit its report on the merit in the court.

This treatment of minorities has more to do with the legacy of the Indian caste system than Islamic theology.

A Pakistani Christian NGO has said that a doctor’s Hippocratic Oath obliges him to treat a patient whose life is at risk in any circumstances, beyond religion and class. The Cecil and Iris Chaudhry Foundation wrote on its Facebook site: “We condemn this incident in the strongest manner. A society becomes exceedingly dangerous when it disregards all norms of humanity.”

Other experts on Pakistan told WWM that this treatment of minorities has more to do with the legacy of the Indian caste system than Islamic theology about how the Ramadan fast could be invalidated by certain ‘restrictions’ upon the faster. For example, there are exemptions from fasting for Muslim travellers or people who are ill.

Unmarried 35-year-old Irfan Masih, who lived with his family, reached his workplace at about 7 am on June 1. Two Christian sanitary workers – Shaukat Masih and Yaqoob Masih – were ordered by their seniors, with Irfan, to unblock sewerage lines. They were not provided with any protective gear, his brother Parvaiz told World Watch Monitor.

“They objected that the lines, clogged for a long time, would be filled with poisonous gases, but the three inspectors told them that they either open the clogged lines or quit their jobs.”

Pakistan’s sewerage system dates back to British colonial times – when pipes were buried under the ground, with manholes used to clean them. When a sewer line is blocked, bamboo is put into the pipeline through the manhole. If it is filled with blackwater sewage, then a cleaner is expected to hold his breath and dive into the filthy water to open the blockage.

Parvaiz Masih told WWM: “When they reached Chorr Road, Yaqoob went down into the manhole. Irfan was a supervisor, so had no responsibility to go down the manhole, but when Yaqoob opened the blocked pipe, the poisonous gas leaked out and he fell unconscious.”

“This same attitude was adopted by two doctors … who did not provide any medical treatment.” – Parvaiz Masih

“My brother Irfan then went down to tie a rope to Yaqoob to bring him up. When Yaqoob was being pulled up, the knot came loose: Yaqoob fell on Irfan, who also fainted. Lastly Shaukat went down to bring them both up but he also fainted.

“It was around 8 am when I received a call and we all raced to the spot. Shaukat’s brother Faisal also reached there. He tied one rope onto himself and took another rope to tie onto the bodies of the three. That’s how we pulled the three, one by one, out of the manhole.

“We called the Civil Hospital to say we were bringing in three unconscious men, expecting it would receive and quickly treat them, but it turned out to be the opposite: the first doctor who came to examine them was Muhammad Yousuf. He told a ward assistant to get the bodies of the three washed and then he would examine them, as he was fasting, and any physical contact with them would mean Allah would disapprove of his fast.”

“This same attitude was adopted by two doctors Allah Daad and Jaam Kambar who did not provide any medical treatment.”

…at least 70 Christians have died since 1988 while cleaning sewerage pipelines.

“Then a fourth doctor Hanif Arisar came, who gave them his full attention. He asked for oxygen to be given to Irfan, but the hospital had no arrangements for it.”

“Shaukat and Yaqoob were shifted to Hyderabad in a critical condition, while my brother was pronounced dead after doctor Hanif examined him.”

Umar Kot police station registered a case against six people, including the three doctors, after Masih’s father, Nazir, complained.

Kanwal Lal Malhi, working with a local NGO, told World Watch Monitor that several organisations and human rights activists helped the Christians to organise the protest. “I remained with the family until the government decided to take up the case. Otherwise, initially, the police were unwilling to listen to them.”

A report by Minority Rights Commission published in 2012 said that at least 70 Christians have died since 1988 while cleaning sewerage pipelines.

Journalist Sameer Ajmal, reported in the daily Urdu Jang newspaper on May 25 that candidates for sewerage cleaner jobs are still expected to dive into blocked manholes.

The incident, reported on all TV channels and in newspapers in Pakistan, has shaken Pakistanis’ conscience; the Sindh Government is considering compensation for the bereaved family.